Smoking Cessation Strategies and Policy Recommendations: Harm Reduction, Electronic Cigarettes, and Abstinence Goal Setting

Abstract

For this dissertation, I completed three manuscripts. In them, I explored tobacco cessation strategies and policy recommendations around electronic cigarette use and abstinence goal setting. In the first, I conducted a thematic analysis of e-cigarette position statements published by tobacco control, public health, and medical organizations. This study was designed to map the range of organizations’ e-cigarette policy positions by identifying and categorizing the types of recommendations they proposed. The second was an empirical analysis of electronic cigarette (e-cigarette) use among callers at the Arizona Smokers’ Helpline (ASHLine). In it, I examined if individuals who use e-cigarettes were more likely to have quit smoking at 7-month follow-up compared to those who never used e-cigarettes. In the third, I examined the quality of quit date goal setting among ASHLine callers using a tested rating scale. Compared to low quality quit date coaching, I assessed whether high-quality coaching was associated with increased in-program quit attempts or number of days to callers’ first quit attempt. The goal of these projects was to explore the merits of integrating abstinence and harm reduction approaches within tobacco control. I argue that current approaches have assisted many, but not all smokers in making healthy behavior changes. Future tobacco control policies and cessation programs should consider offering more inclusive and flexible services that appeal to a wider range of smokers. Abstinence and harm reduction need not be positioned as mutually exclusive approaches to smoking prevention.